This population-based study proposes to continue the examination of changing long-term trends in the descriptive epidemiology of acute myocardial infarction (AMI) and out-of hospital deaths due to coronary heart disease (CHD) in residents of the Worcester, MA, metropolitan area. The specific objectives of this population- based study are to examine contemporary (2013 and 2015), as compared with prior (1975-2011), trends in the annual incidence and attack rates of AMI, hospital and post-discharge survival rates, management practices, and out-of-hospital deaths attributed to CHD. To accomplish these and several additional secondary study objectives, this investigation will be carried out in the 11 acute care general hospitals providing care for residents of central Massachusetts. All new (incident) and recurrent episodes of definite AMI occurring in greater Worcester residents during 2013 and 2015 will be identified from discharge diagnostic printouts obtained from all metropolitan Worcester hospitals of patients with a primary or secondary discharge diagnosis of AMI and related CHD rubrics. The medical records of these patients will be individually reviewed for validation purposes according to pre-established criteria for AMI. Abstraction of the medical records of patients satisfying the study diagnostic and geographic eligibility criteria will be carried out by trained physicians with the recording of demographic, clinical, treatment, and outcomes related data. A review of records for additional hospitalizations and a search of death certificates will be carried out to examine the long-term survival status of discharged hospital patients from each of the proposed 2 study years, as well as those identified previously, through 2017. Death certificates will be reviewed to identify cases of out-of-hospital deaths attributed to CHD occurring during 2013 and 2015. In addition, we will assess the feasibility of carrying out an innovative approach for real time surveillance of acute coronary disease in this central MA population through the development of natural language processing systems that will automatically extract clinical information from electronic medical records in our most recently hospitalized patient cohort in 2015. Monitoring contemporary trends in our principal study outcomes remains timely given the ongoing publication and dissemination of treatment guidelines and recommendations by national agencies and emphasis on improving quality in processes of care. Given the real world setting of this investigation, important contemporary insights would be provided into current gaps between ideal and achieved patient care in the broader community setting, to assist in the development of novel educational approaches and incentives to provide more optimal patient care. The results of this investigation will provide important insights from a 40 year (1975-2015) vantage point about the magnitude of, mortality from, and treatment approaches used in the management of the nation's leading cause of death as it affects residents of a large New England metropolitan area.